A Short-term Comparative Study on Efficacy and Safety of Standard Transurethral Resection and High Power (80W) Potassium-Titanyl-Phosphate Laser Vaporization of the Prostate / 대한비뇨기과학회지

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard treatment for symptomatic benign prostate hyperplasia, but significant complications are associated with this procedure. The aim of this study was to compare the standard TURP with the high power (80W) potassium-titanyl-phosphate laser (KTP/532; Greenlights PVTM laser system; Laserscope, San Jose, USA) to elucidate the efficacy and safety of laser treatment. MATERIALS AND METHODS: We performed comparative trials of 40 patients suffering with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia from February 2005 to June 2005. Twenty patients were treated with TURP (Group I) and 20 patients were treated with KTP (Group II). All patients were assessed preoperatively and at an interval of 3 months postoperatively based on the International Prostate Symptom Score (IPSS), the quality of life (QoL) index, changes in maximum urinary flow rate (Qmax), and the postvoid residual urine (ml). The safety parameters we evaluated included the operative time (minutes), the postoperative catheterization time (day) and the blood loss (ml). The Kolmogorov- Smirnov & Shapiro-Wilk test, Student's t-test, Student's t-test (paired), and Fisher's Exact test were performed for statistical analysis. RESULTS: The mean age of each group was 68.9+/-9.9 years (group 1) and 63.9+/-9.7 years (group II), and the prostate weight was 49.5+/-15.4cc and 45.0+/-17.3cc, respectively. The mean operation time was shorter for group II (27.7+/-13.6min) than for group I (48.1+/-22.6min) (p<0.05). The mean catheterization time was 5.6+/-1.82 and 1.36+/-1.64 days, respectively, (p<0.001). The blood loss was lower in group II (11.7+/-11.4ml) than in group I (181.9+/-168.17ml, respectively) (p<0.001). CONCLUSIONS: In this preliminary short-term study, KTP Laser enucleation of the prostate was shown to be an effective alternative for treating benign prostate hyperplasia as compared with standard TURP.

A Study for the Development of Prostate Associated Urinary Tract Symptoms in Occupational Taxi Drivers / 대한비뇨기과학회지

PURPOSE: This study was performed in order to evaluate the factors related to the development of lower urinary tract symptoms (LUTS) and prostate associated symptoms of professional taxi drivers in Korea, who had to abstain from adequate voiding on working time. MATERIALS AND METHODS: A prospective study, including 192 professional taxi drivers and 120 sedentary desk workers (control group), was performed. The subjects were assessed by a questionnaire that was composed of three parts; structurized 13 basic questions including voiding abstinence, International Prostate Symptom Score (IPSS), and National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). All possible factors that affect the presence of LUTS and prostate associated symptoms were analyzed, such as age, the duration of service, on-duty time per day, and length of voiding abstinence. RESULTS: There was no significant difference in age between the taxi driver group and the control group. The duration of service of the control group was significantly longer, however, on-duty time per day was significantly longer in the taxi driver group than the control group (p<0.01). The length of voiding abstinence during duty was significantly longer in the taxi driver group than the control group (p<0.01). The total score, irritative symptom score, obstructive symptom score, and quality of life score of the IPSS questionnaire were significantly high in the taxi driver group (p<0.01). Also, the total score, pain score, urinary symptom score, and quality of life impact score of the NIH-CPSI questionnaire were significantly higher in the taxi driver group (p<0.01). CONCLUSIONS: LUTS and prostate associated symptoms were more frequent and severe in the taxi driver group than the control group. The habitual abstinence of voiding and prolonged sedentary working environments could contribute to poor voiding function and prostate associated symptoms in taxi drivers.

Clinical Significance of Prostatitis in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The clinical significance of prostatitis associated with benign prostatic hyperplasia (BPH) remains to be determined. We determined the differences in the prevalence, pattern, clinical symptoms and outcome in BPH patients both with, and without prostatitis. MATERIALS AND METHODS: This prospective study included 134 consecutive patients with lower urinary tract symptoms related to BPH. The patients were divided into 2 groups relating to the expressed prostatic secretion caused by prostate massage (group 1: more than 10 leukocytes per high power field, group 2: less than 10 leukocytes per high power field). Tamsulosin, a selective alpha1-blocker, and finasteride were administered at doses of 0.2 and 5mg, respectively, once a day for one year. The primary efficacy criteria included, symptomatic improvement (International Prostate Symptom Score: I-PSS), maximum flow rate (Qmax) and residual urine volume. RESULTS: Prostatitis was identified in 67 of 119 patients (56.3%); the other 15 patients failed the prostatic massage. Of the patients with associated prostatitis, 8 (11.9%) showed bacterial growth. The serum PSA level was higher in group 1 than in group 2, but there were no significant differences in the other clinical parameters. There was no significantly difference in the improvement of the total I-PSS after treatment between the two groups. However, in group 1, the rritative symptom was significantly less improved (p<0.05). CONCLUSIONS: Prostatic inflammation is a common finding in patients with symptoms of BPH. In such cases, the response to medical treatment for irritative symptoms was inferior in the BPH only cases. There is a need for more studies to distinguish chronic prostatitis and BPH, and to ascertain any additional treatment requirements.

Prognostic Value of Peak Flow Rate and Post Void Residual Urine Measured by Abdominal Compressing Immediately after TURP / 대한비뇨기과학회지

PURPOSE: Although a transurethral resection of the prostate (TURP) is the most effective treatment method for benign prostatic hyperplasia (BPH), it is difficult to predict the exact prognosis with this method. The peak flow rate (PFR) and post void residual urine (PVR), measured by abdominal compressing immediately after TURP in the operating room, were evaluated to see if they correlated with the surgical outcome. MATERIALS AND METHODS: Fifty patients, having undergone TURP, had their PFR and PVR measured by abdominal compressing, both before and after TURP in the operating room. The abdomen was compressed to 100cm H2O of intravesical pressure with a concrete test hammer. All patients were requested to undergo uroflowmetry, and their international prostate symptom scores (IPSS) were assessed, 3 months after surgery. RESULTS: The PFR and PVR, measured by abdominal compressing immediately after TURP, correlated well with the PFR measured 3 months after the TURP (p<0.05). Higher PFR, lower PVR and a greater improvement in the IPSS were observed, but these were not statistically significant. CONCLUSIONS: In conclusion, the PFR and PVR, measured by abdominal compressing immediately after TURP, are thought to be a good parameter for predicting the prognosis of TURP.

Study on Consciousness of Korean Adults for Circumcision / 대한비뇨기과학회지

PURPOSE: There is controversy surrounding the benefits and risks to health of a circumcision of the male prepuce. The purpose of this study was to provide educational material to the general population and medical doctors to help them understand appropriate opinions relating to a circumcision. MATERIALS AND METHODS: A prospective study, including 1,124 adult men, 772 women, with sons, and 971 doctors, was performed. The subjects were interviewed, in detail, about their cognition of circumcision, their circumcision status, their age at circumcision, how many men received circumcisions, their reasons and thoughts relating to circumcision, the pros and cons and their current knowledge of the health benefits and risks associated with male circumcision. RESULTS: 81% of the general subjects, and 77% of the doctors, taking part in the study, were circumcised. The most common age at circumcision, accounting for 34% of the subjects, was over 18 years old. 77% of the general subjects, and 80% doctors, agreed with circumcision. The greatest motive for a circumcision, accounting for 38% of the subjects, was their parents wish. The satisfaction rate of a circumcision was 93%. Most Koreans (69%) considered that a circumcision is an ordinary operations in males. CONCLUSIONS: In this study, most Korean men were found to be circumcised, and were very much satisfied with the results, and on most occasions the procedure had been performed after adolescence. These results suggest that, in Korea, circumcision has a position as a customary conduct, and in itself is inevitable. Therefore, it is essential to explain the advantages and disadvantages of a circumcision to patients and their parents.

Expression of Transforming Growth Factor-beta1 and Its Receptors in N-butyl-N-(4-hydroxybutyl) Nitrosamine-induced Rat Bladder Carcinogenesis / 대한비뇨기과학회지

PURPOSE: To determine the role of TGF-beta1, and its receptors, in bladder tumor, their expressions at various stages of chemically-induced rat bladder carcinogenesis were investigated. MATERIALS AND METHODS: Forty female Sprague-Dawley rats (200-250g) were given drinking water containing 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN), and twenty rats, used as a control group, were given tap water. After 10, 20, 25 and 30 weeks of the administration, the bladders of the rats were harvested. The control and BBN-treated rat bladders were analyzed for the expressions of TGF-beta1, and its receptors (RI, RII and RIII), in the mRNA by a real-time quantitative polymerase chain reaction. The protein expression was determined by immunohistochemistry. RESULTS: The expressions of the TGF-beta1 increased in the mRNA with the BBN treatment, while those of the TGF-beta receptors decreased. The up-regulation of TGF-beta1 was statistically significant after 25 weeks of BBN treatment, but down-regulations of RI, RII, and RIII were significant after 20, 25, and 30 weeks of BBN treatment, respectively (p<0.05). The immunohistochemical analysis demonstrated that the TGF-beta1, and its receptors, were localized in the tumor cytoplasm, and their intensities reflected the expression in the mRNA of these tissues. CONCLUSIONS: These data suggest that the enhanced expression of TGF-beta1, as well as the loss of the expressions of RI, RII, and RIII, at the various stages, contributes to the carcinogenesis of the bladder and tumor progression.

Efficacy of alpha-Blocker and Finasteride Combination Therapy for Benign a Prostatic Hyperplasia with a Prostate Volume Less than 40 Grams / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the efficacy of a combination drug therapy (tamsulosin plus finasteride) for benign prostatic hyperplasia, with a small prostate volume of less than 40 grams. MATERIALS AND METHODS: One hundred and twenty-three patients, with symptomatic benign prostatic hyperplasia of less than 40 grams, were analysed. Group 1 (n=67) had been treated with a combination of finasteride (5mg/day) and tamsulosin (0.2mg/ day), and Group 2 (n=56) with tamsulosin only (0.2mg/day) over a 12 month period. The patients were periodically assessed by IPSS (international prostate symptom score), uroflowmetry and residual urine, during the treatment period. RESULTS: The mean changes in the total symptom score, obstructive and irritative symptom score for group 1 and group 2 at 1 year were -7.21+/-7.44 (39.86%), -4.79+/-5.07 (45.02%) and -2.42+/-3.25 (48.11%), and -7.39+/-9.98 (43.06%), -4.82+/-6.91 (45.21%) and -2.39+/-4.00 (37.82%) points, respectively. The mean changes in the peak urinary-flow rates and postvoid residual urine for group 1 and group 2 at 1 year were 2.07+/-5.42 (16.65%)ml/s and -31.58+/-60.99 (56.47%)ml, and 2.38+/-6.57 (16.53%)ml/s and -34.78+/-86.77 (50.24%)ml, respectively. The effects of the combination of finasteride and tamsulosin were no greater than the tamsulosin monotherapy (p>0.01). CONCLUSIONS: A combination of finasteride and tamsulosin is no more effective than tamsulosin alone, in patients with benign prostatic hyperplasia, with a prostate volume of less than 40 grams.

Changes of Nitric Oxide and Cell Proliferation after Bacillus Calmette-Guerin and Nitric Oxide Synthase Inhibitor Treatment on Murine Bladder Tumor-2 Cell Line / 대한비뇨기과학회지

PURPOSE: We hypothesize that the cytolytic activity of Bacillus Calmette-Guerin (BCG) may act through nitric oxide (NO) production, and that cell death is correlated with apoptosis, changes of NO and cell proliferation following BCG and/or nitric oxide synthase (NOS) inhibition treatment of a murine bladder tumor-2 (MBT-2) cell line. If these cell lines show cell death due to apoptosis was also determined. MATERIALS AND METHODS: NO production and proliferation activity of the MBT-2 cell line were measured after stimulation, with BCG and/or L-NAME, using an enzyme- linked immunosorbent assay (ELISA). After incubation of the MBT-2 cells with BCG and/or L-NAME, the cell cycle was analysis was performed by immunocytometry. RESULTS: The production of NO in the MBT-2 cells was significantly increased by the BCG. The BCG had direct dose-dependent cytotoxic effects on the MBT-2 cell line. After the L-NAME treatment, both the NO production and cytotoxicity were decreased (p<0.05). When the MBT-2 cells were cultured with BCG, the apoptotic cell ratio increased compared to that of the MBT-2 cells treated with L-NAME (p<0.05). CONCLUSIONS: The up-regulation of the production of NO following BCG treatment of the MBT-2 cell line may be due, in part, to the cytolytic action of the BCG. The cell death, when BCG was instilled, correlated with apoptosis.

Deletion of Y-Chromosome Specific Genes in Testicular Germ Cell Tumor / 대한비뇨기과학회지

PURPOSE: We hypothesized that the deletion of Y-chromosome specific genes is associated with testicular tumors. To test this hypothesis, we analyzed the expressions of five Y-chromosome specific genes in testicular tumor samples. MATERIALS AND METHODS: Thirty-five human testicular tumor specimens were processed for the micro-dissection of pure epithelial cells. The DNA was extracted, and polymerase chain reactions performed using five different specific primers (ZFY, DYS203, SMCYM45, GDB187507 and RH38676). These primers were designed based on sequences available in the public genome data bank. RESULTS: Deletion was observed in 88.6% of the testicular tumor specimens with at least one Y-chromosome specific gene. The losses of DYS203, ZFY, SMCYM45, RH38676 and GDB187507 were shown in 51.4, 42.9, 40, 28.6 and 20% of cases, respectively. There was a different pattern of loss of the Y-chromosome specific genes according to the histologic types of germ cell tumor. The losses of the DYS203 and GDB187507 genes were seen more frequently in the advanced stages. CONCLUSIONS: There was a significant loss of the Y-chromosome specific genes in testicular germ cell tumors. The loss of the DYS203 gene was observed in about half the cases, and was more frequent in the higher stages of testicular tumor. The loss of Y-chromosome specific genes is associated with testicular tumors, suggesting their role in the pathogenesis of this disease.

Primitive Neuroectodermal Tumor of the Kidney with CD99 Positive Staining / 대한비뇨기과학회지

Primitive neuroectodermal tumors (PNETs) are primitive neuroblastic tumors that, unlike neuroblastomas, arise outside the autonomic nervous system, but very few cases with a renal origin have been described. The immunohistochemical staining for CD99 is useful in their diagnosis. A case of renal primitive neuroectodermal tumor, in a 61- year-old man presenting with a painless gross hematuria is reported. The immunohistochemical staining of the renal mass was strongly positive for CD99.

Effect of Finasteride on Sexual Function in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study is to evaluate the change in sexual function after treatment with finasteride in patients with benign prostatic hyperplasia using the validated International Index of Erectile Function (IIEF). MATERIALS AND METHODS: Sixty patients, who were treated with 5mg finasteride daily due to a benign prostatic hyperplasia, were assessed with the IIEF questionnaires prior to treatment and after 3 months of medication. Nine patients were excluded due to an erectile dysfunction. The patients' age ranged 50 to 78 years with a mean age of 63.3 years (by age group: 50-59 years, n=13; 60-69 years, n=27; 70-79 years, n=11). The total IIEF scores and all 5 IIEF domains scores were calculated to investigate the change in sexual function. RESULTS: The mean total IIEF scores decreased significantly from 43.24+/-15.02 to 37.00+/-17.78 after administering finasteride (p<0.05). The mean decrease in the total IIEF scores for the men in their fifties, sixties and seventies were 4.69, 7.59 and 4.73, respectively, and was most prominent in the sixties. Among the mean scores of each IIEF domain, the erectile function scores decreased from 17.53+/-6.83 to 15.04+/-7.78 (p<0.05), the intercourse satisfaction scores decreased from 7.59+/-2.86 to 6.25+/-3.43 (p<0.05), the orgasm function scores decreased from 6.37+/-2.65 to 5.16+/-3.07 (p<0.05), the sexual desire scores decreased from 5.47+/-1.71 to 4.86+/-2.06 (p<0.05), and the overall satisfaction scores decreased from 6.27+/-2.44 to 5.69+/-2.62 (p<0.05). CONCLUSIONS: With this IIEF questionnaire, the generalized sexual function decreased after finasteride treatment in patients with benign prostatic hyperplasia, particularly in those aged 60-69 years.

Experience of Extracorporeal Shock Wave Lithotripsy with Piezolith 2300 Device in 2077 Patients with Urinary Tract Calculi / 대한비뇨기과학회지

PURPOSE: An experience of extracorporeal shock wave lithotripsy (ESWL) using the Piezolith 2300 lithotriptor in 2077 (2223 renal units) patients with urinary tract calculi is presented. MATERIALS AND METHODS: The records of 2077 patients who underwent an ESWL between April 1990 and March 2001 were reviewed retrospectively. The ESWL treatment sessions, success rate, auxiliary procedures, and complications according to the stone size and location were analyzed. RESULTS: Of 2223 renal units (2077 patients), 781 (35.1%) had renal, 1150 (51.7%) had ureteral and 292 (13.2%) had multiple stones. Of these cases 1116 (50.2%) had stones 3.0cm in size, with an 86.4% overall success rate. For auxiliary measures, the push back procedure was done in 23 cases. The treatment modalities of the unsuccessful cases were open surgery in 95 cases and ureteroscopic stone removal in 31. A stone street developed in 93 patients. However, there were no other significant complications. CONCLUSIONS: Extracorporeal shock wave lithotripsy with a piezolith 2300 lithotriptor is to be a safe and efficient outpatient procedure for the initial treatment of properly selected urinary tract calculi.

Quantitative Analysis of Transforming Growth Factor-beta1 in Renal Cell Carcinoma / 대한비뇨기과학회지

Purpose: The transforming growth factor-beta (TGF-beta) is a peptide that has diverse biologic actions in human tissue and is thought to contribute to tumor development and progression. Increased TGF-beta1 levels were found in several types of malignant tumors. TGF-beta1 expression in RCC and adjacent normal kidney tissues was examined to determine the TGF-beta1 in renal cell carcinoma (RCC). MATERIALS AND METHODS: The TGF-beta1 protein levels in cancer and a normal portion of a specimen were analyzed in 61 radical nephrectomized clear cell type RCC by an enzyme-linked immunosorbent assay (ELISA), with the results compared with the clinicopathological characteristics. Immunohistochemical staining was performed to localize their expression. RESULTS: Compared with non-tumor kidney specimens, primary renal cell carcinoma demonstrated a significantly higher TGF-beta1 protein level (p<0.001). There were significant differences in the TGF-beta1 level among the histological grade (p<0.01). The tissue TGF-beta1 level was the highest in T4 stage, but there was no statistical significance between the T stages. Immunohistochemical analysis demonstrated that TGF-beta1 was localized to the tumor cytoplasm and their intensity reflected the protein expression level in these tissues. CONCLUSIONS: These results suggest that enhanced TGF-beta1 expression contributes to carcinogenesis and tumor progression in the later stages of renal cell carcinoma.

Malacoplakia of the Prostate / 대한비뇨기과학회지

Malacoplakia is a rare granulomatous inflammatory disease that most frequently involves the urinary tract, particularly the urinary bladder and may involve the testis, epididymis, lung, bone, colon, prostate, female genital organs, and the retroperitoneum, etc. A malacoplakia of the prostate is a very rare disease that is associated with a chronic urinary tract infection. It is often misinterpreted as granulomatous prostatitis, and may clinically mimic prostate cancer. The major cellular component of malacoplakia is the macrophage and the diagnostic hallmark is a characteristic inclusion, the Michaelis-Gutmann body. We recently experienced a case of malakoplakia of the prostate in a 74-year-old man, that was found incidentally in a TRUS-guided biopsy to confirm a suspected prostate cancer.

The Prognostic Factors Affecting Survival in Muscle Invasive Bladder Cancer Treated with Radiotherapy / 대한방사선종양학회지

PURPOSE: This study analyzed the prognostic factors affecting the survival rate and evaluated the role of radiation therapy in muscle-invading bladder cancer. MATERIALS AND METHODS: Twenty eight patients with bladder cancer who completed planned definitive radiotherapy in the Departments of Therapeutic Radiology and Urology, Chonnam National University Hospital between Jan. 1986 to Dec. 1998 were retrospectively analyzed. The reviews were performed based on the patients' medical records. There were 21 males and 7 females in this study. The median of age was 72 years old ranging from 49 to 84 years. All patients were confirmed as having transitional cell carcinoma with histological grade 1 in one patient, grade 2 in 15, grade 3 in 9, and uninformed in 3. Radiation therapy was performed using a linear accelerator with 6 or 10 MV X-rays. Radiation was delivered daily with a 1.8 or 2.0 Gy fraction size by 4 ports (anterior-posterior, both lateral, alternatively) or 3 ports (Anterior and both lateral). The median radiation dose delivered to the isocenter of the target volume was 61.24 Gy ranging from 59 to 66.6 Gy. The survival rate was calculated by the Kaplan-Meier method. Multivariate analysis was performed on the prognostic factors affecting the survival rate. RESULTS: The survival rate was 76%, 46%, 33%, 33% at 1, 2, 3, 5 years, respectively, with 19 months of median survival. The potential factors of age (less than 70 years vs above 70), sex, diabetes mellitus, hypertension, hydronephrosis, T-stage (T3a vs T3b), TUR, chemotherapy, total duration of radiotherapy, radiation dose (less than 60 Gy vs above 60 Gy), and the treatment response were investigated with uni- and multivariate analysis. In univariate analysis, the T-stage ( p=0.078) and radiation dose ( p=0.051) were marginally significant, and the treatment response ( p=0.011) was a statistically significant factor on the survival rate. Multivariate analysis showed there were no significant prognostic factors affecting the survival rate. CONCLUSION: The treatment response and radiation dose are suggeted as the statistically significant factors affecting the survival rate of muscle invasive bladder cancer. A Further prospective randomized study is needed to confirm these prognostic factors.

Effect of Percutaneous Aspiration with Sclerotherapy of the Simple Renal Cyst / 대한비뇨기과학회지

PURPOSE: Recently, a percutaneous aspiration with sclerotherapy has become the treatment of choice for the symptomatic, large, and simple renal cyst because of its minimal invasiveness and high effectiveness. The recurrence rate of a percutaneous aspiration only, was reported to range from 30 to 70%. This study was performed to evaluate the effects of percutaneous aspiration with sclerotherapy. MATERIALS AND METHODS: The results of the treatment in 36 cases of simple renal cysts from October 1993 to December 1999 were evaluated. The symptoms associated with simple renal cysts were: flank pain or discomfort (50%), none (47.2%) and a palpable mass (2.8%). The simple renal cysts were treated with a percutaneous aspiration only in 6 cases, a percutaneous aspiration with sclerotherapy using 99% ethanol in 21 cases or a 10% minocycline solution in 9 cases. All patients were followed up by ultrasound for 6 to 56 months (mean 18 months). RESULTS: Complete collapse, and partial collapse rate of the renal cysts were 1/6 (16.7%), 2/6 (33.3%) in the aspiration only group, 6/21 (28.6%), 14/21 (66.7%) in the 99% ethanol group and 3/9 (33.3%), 4/9 (44.4%) in the 10% minocycline solution group, respectively. CONCLUSIONS: Therefore, a percutaneous aspiration with sclerotherapy using either 99% ethanol or 10% minocycline solution appears to be an effective way to the prevent re-accumulation of cystic fluid. However, the success rates in the percutaneous aspiration with sclerotherapy using 99% ethanol and 10% minocycline solution were not significantly different.

Differentiation of Infiltrating Urothelial Tumor of Renal Pelvis from Renal Cell Carcinoma Invading into Renal Pelvis or Calyx / 대한비뇨기과학회지

PURPOSE: It is difficult to differentiate urothelial tumours of the renal pelvis, invading the renal parenchyma, from renal cell carcinomas, invading the renal pelvis or calyx. The purpose of this study was to assess the differences between the two conditions. MATERIALS AND METHODS: We retrospectively reviewed the medical records, and imaging studies, of 17 patients who underwent nephroureterectomy with bladder cuff excision for urothelial tumours of the renal pelvis, with parenchymal invasion, and of 30 patients who underwent radical nephrectomy for renal cell carcinomas, invading into the renal pelvis or calyx. We assessed the differences in clinical symptoms, urine cytology, intravenous urography, and CT findings between the two conditions. Pearson chi-square tests, with continuity corrections, were performed for statistical analyses. RESULTS: Renal cell carcinomas showed gross hematuria in only 10 cases (33%), positive findings of urine cytology in 1 case of 9 cases (11%). CT scans demonstrated contour bulging in 25 cases (83%), preservation of reniform shape in 5 cases (17%), peripheral location of tumour in 25 cases (83%), and abnormal CT nephogram in 1 cases (3%). In contrast, urothelial tumour of the renal pelvis showed gross hematuria in 13 cases (76%), positive findings of urine cytology in 9 cases of 15 cases (60%). CT scans demonstrated contour bulging in 1 cases (6%), preservation of reniform shape in 16 cases (94%), central location of tumour in all cases (100%), and abnormal CT nephogram in 10 cases (59%). There was no significant difference between renal cell carcinomas and urothelial tumours of the renal pelvis in blood chemistry or IVP. There were no cases of renal cell carcinoma concurrently with bladder tumour, while 2 cases (12%) of urothelial tumour of the renal pelvis had bladder tumours at the same time. CONCLUSIONS: The presence of gross hematuria, positive findings in urine cytology, the presence of bladder tumours, and tumour location, renal contour changes and CT nephogram in CT scans may be helpful in distinguishing both disease entities.

Assessing the Effect of Finasteride by Prostate Tissue Composition / 대한비뇨기과학회지

PURPOSE: We determine whether the epithelial content of the prostate and prostate volume before treatment related to the effect of finasteride. MATERIALS AND METHODS: Transrectal ultrasonography (TRUS) guided sextant biopsies of the prostate were obtained from 30 male subjects with symptomatic benign prostatic hyperplasia (BPH) prior to initiating therapy with finasteride. Anti-cytokeratine staining and computer-assisted quantitative color image analysis were utilized to quantify the area density of glandular epithelium, stroma and glandular lumen. The clinical response to finasteride was based upon changes in peak urinary flow rate (Qmax), post voiding residual urine (PVR), International Prostate Symptom Score (IPSS), serum prostate specific antigen (PSA) and prostate volume. RESULTS: The average compositions among the 30 glands were as the following: epithelium 15.46.3%; stroma 75.3+/-8.6%; lumen 9.3+/-4.5%. The mean prostate volume was 52.0+/-25.3cc. Pretreatment epithelial content and pretreatment prostate volume had no relation with finasteride effect in Qmax, PVR, IPSS and PSA except in change of prostate volume. We found a linear correlation between pretreatment epithelial volume and finasteride-induced prostate volume reduction (p<0.01). CONCLUSIONS: Finasteride-induced prostate volume reduction has a correlation with pretreatment epithelial volume.

Difference of Cough and Valsalva Maneuvers in the Dynamic Testing of Stress Urinary Incontinence

PURPOSE: The aim of the study was to evaluate the relationship between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) in the patients with stress incontinence and to determine the correlation between maximal urethral closure pressure(MUCP) and leak point pressure. MATERIALS AND METHODS: Thirty women with stress urinary incontinence were included. Two women were excluded from the evaluation because of detrusor instability. At the bladder volume of 200-300ml cough leak-point pressure and Valsalva leak-point pressure were measured in the sitting position by using 8Fr intravesical catheter. RESULTS: Valsalva leak-point pressure was significantly lower than cough leak-point pressure (69.4+/-24.5 versus 86.6+/-28.1cmH2O, p<0.0001). If intrinsic sphincter deficiency was defined as a leak-point pressure of 60cmH2O or less, 21.4% of women fulfilled this criterion using the cough leak-point pressure compared to 42.8% if the Valsalva leak-point pressure is used. Valsalva leak-point pressure and maximal urethral closure pressure were statistically correlated (p<0.05). However, a correlation coefficient of 0.38 demonstrated poor clinical relationship. CONCLUSION: Cough leak-point pressures were significantly higher than Valsalva leak-point pressures. Cough and Valsalva maneuvers seem to result in a different reaction of the pelvic floor. Valsalva leak-point pressure has more statistical correlation to the maximal urethral closure pressure than cough leak-point pressure. So Valsalva leak-point pressure may have a additional benefit for detecting type III stress urinary incontinence. However, variations in Valsalva leak-point pressure measurement must be precisely descibed, standardized, and validated before a technique can be advocated for clinical use.

A Case of Fibrosarcoma of Kidney / 대한비뇨기과학회지

Fibrosarcoma of the kidney is rare and usually developed from renal capsule. In the past, this diagnosis was made more frequently and was easily mistaken for leiomyosarcoma. With improved histochemical techniques and a better understanding of mesenchymal derived tumors, the diagnosis of fibrosarcoma of the kidney is made rarely. Microscopically, this tumor discloses fascicular arrangement and herringbone appearance of spindle cells. Positive immunohistochemistry for vimentin along with nonreactivity of tumor cells for cytokeratin, S-100 protein, actin, and CD34 supported the diagnosis of fibrosarcoma. Herein, we report a case of fibrosarcoma of kidney with a brief review of the literatures.